Provider Demographics
NPI:1720381031
Name:WARNER, ANDREW OWEN (SOIDC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:OWEN
Last Name:WARNER
Suffix:
Gender:M
Credentials:SOIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1ST MARINE SPECIAL OPERATIONS BN.
Mailing Address - Street 2:MEDICAL BOX 555341
Mailing Address - City:CAMP PENDLETON
Mailing Address - State:CA
Mailing Address - Zip Code:92055-5341
Mailing Address - Country:US
Mailing Address - Phone:760-725-6596
Mailing Address - Fax:
Practice Address - Street 1:1ST MARINE SPECIAL OPERATIONS BN.
Practice Address - Street 2:MEDICAL BOX 555341
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055-5341
Practice Address - Country:US
Practice Address - Phone:760-725-6596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman